The Skin & Wellness Center PLLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

THE SKIN & WELLNESS CENTER PLLC

Practice address

125 S Main St Ste a
Bladenboro, NC 28320-8440

Phone

(910) 809-0030

NPI assigned

Jun 10, 2024

Organization subpart

No

Name

Mrs. Crystal Edwards, PA-CNPI 1992795041

Title

Owner/Provider

Phone

(910) 809-0030

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Edwards, P.A.-C

  • Physician Assistant
  • Bladenboro, NC
  • NPI 1992795041

  NC

  Medicare reassignment Care Compare group Authorized official
• Tiffany Anne Clowers, PA-C

  • Medical Physician Assistant
  • Bladenboro, NC
  • NPI 1942667449

  NC

  Medicare reassignment Care Compare group

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 29, 2024.

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1104668219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88",
            "address_2": "125 S MAIN ST SUITE A",
            "city": "BLADENBORO",
            "state": "NC",
            "postal_code": "28320",
            "telephone_number": "910-809-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S MAIN ST STE A",
            "city": "BLADENBORO",
            "state": "NC",
            "postal_code": "283208440",
            "telephone_number": "910-809-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SKIN & WELLNESS CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "910-809-0030",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992795041",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Bladenboro, NC
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.